Cancer in Africa is 'Like a Runaway Train'

Zosia Chustecka

February 04, 2011

February 4, 2011 — Of the 16 million new cases of cancer that are predicted to occur annually by the year 2020, the majority (70%) will be in developing countries.

A "call to action" to address cancer in developing nations was proposed last year by experts writing in the Lancet (2010;376:1186-1193), and the problem has been highlighted in the run-up to today's World Cancer Day.

Among the developing world, African countries are the least able to cope, according to AfrOx, the Africa Oxford Cancer Foundation, a registered charity based in the United Kingdom.

"Lack of resources and basic infrastructure mean that most Africans have no access to cancer screening, early diagnosis, treatment, or palliative care. Consequently, a diagnosis of cancer leads, in most cases, to a painful and distressing death," AfrOx reports.

The rising incidence of cancer in Africa is like a runaway train.

"The rising incidence of cancer in Africa is like a runaway train coming down the track," said Alan Milburn, chair of AfrOx, and former British Secretary of State for Health.

"The global community must act now to prevent the situation from deteriorating," he said in a statement. "One third of cancers affecting people in the developing world are potentially preventable and another third treatable if detected early."

Highlighted in Latest Global Report

The problem of cancer in Africa is highlighted in a special section of a new report being publicized by the American Cancer Society: Global Cancer Facts & Figures . It is also emphasized in a report of global cancer statistics published online February 4 in CA: A Cancer Journal for Clinicians.

In Africa, the incidence of cancer is increasing, but it remains a low public health priority because resources are limited and there are other pressing medical problems, such as AIDS/HIV infection, malaria, and tuberculosis.

The International Agency for Research on Cancer estimates that there were 681,000 new cancer cases and 512,400 cancer deaths in Africa in 2008. These numbers are projected to nearly double by 2030 because of the aging and growth of the population; this rise might be even sharper, the report warns, because unhealthy behaviors and lifestyles associated with economic development and urbanization, including smoking, unhealthy diet, and physical inactivity, are increasingly being adopted.

The most dominant cancers in Africa relate to infectious agents (cervical, liver, Kaposi's sarcoma, urinary bladder). In 2008, cervical cancer accounted for 21% of all new cancer diagnoses in women, and liver cancer accounted for 11% of all new cancers in men.

Another issue is that most cancers diagnosed in Africa are at an advanced stage of the disease, the American Cancer Society notes in a commentary on the report. This is due to a lack of screening and early detection services, but there is also a limited awareness of the early signs and symptoms of cancers among the public and healthcare providers. In addition, there is a stigma associated with a diagnosis of cancer in most parts of Africa.

Survival after a diagnosis of cancer is much worse in the developing world than in the developed world, especially for cancers that can be detected by screening. For example, the 5-year survival rate for breast cancer in Gambia, Uganda, and Algeria is less than 50%, in contrast to the 90% seen in the United States.

AfrOx Working With ESMO

AfrOx is working with the European Society for Medical Oncology (ESMO) to "galvanize the global community" into doing something about this problem.

ESMO president David Kerr, MD, professor of cancer medicine at the University of Oxford, United Kingdom, was one of the founders of AfrOx in 2007.

AfrOx poster promoting exercise

A series of cancer prevention and awareness posters designed for use in Africa has been developed in collaboration with the ESMO Developing Countries Task Force. These posters aim to demonstrate how simple lifestyle changes can greatly reduce the likelihood of developing many cancers, and highlight, among other things, smoking cessation, daily exercise, healthy diet, and the importance of hepatitis B vaccination in preventing liver cancer.

AfrOx poster promoting hepatitis B vaccination

The posters have already been launched in Ghana, where several other projects have begun, all in collaboration with the Ghanaian Ministry of Health.

The initial focus is in Ghana, AfrOx explains, because of its historic ties with Britain, its record of good governance, and the commitment of local policy makers and clinicians to control cancer.

Ghana has a population of 23 million, and the most common cancers are liver, prostate, breast, and cervical. However, there are only 2 oncology centers (in Accra and Kumasi), only 4 oncologists, and no specialist cancer nurses.

"The long-term aim is to establish a framework in which Ghana could potentially serve as a regional hub for supporting the development of cancer services in neighboring countries in West Africa," AfrOx reports.

One focus is improving the treatment of childhood cancers, focusing in particular on Burkitt's lymphoma (which accounts for 50% tumors), Wilms' tumor, and retinoblastoma. All of these can be treated successfully at an affordable cost, the Foundation notes, but cure rates for childhood cancer are currently only around 5% in Africa, compared with 75% to 80% in the United Kingdom.

One of the projects involves a 5-year twinning program between a British hospital and the pediatric cancer unit at the Korle-Bu Teaching Hospital in Accra. Korle-Bu sees about 90 to120 new childhood cancer cases each year, and has access to good surgical and radiotherapy facilities, but there are major problems with understaffing and inadequate diagnostic capacity. Another problem is that the costs of drugs, blood products, and investigations are borne by the parents. AfrOx aims to set up "long-term sustainability funding" for this center, and hopes that it will be used as a template for developing other cancers centers in the region.

Other Projects in Africa

Other organizations also have ongoing projects to improve cancer care in Africa, as previously reported by Medscape Medical News.

In Malawi and Rwanda, Partners in Health, a nonprofit healthcare organization based in Boston, Massachusetts, is working with national ministries of health to operate health centers and hospitals in rural undeserved areas. That organization was cofounded by Paul Farmer, MD, PhD, chair of the Department of Global Health and Social Medicine, Harvard Medical School, in Boston, and Harvard-based facilities have provided support and training for local physicians and nurses. Even in the absence of oncologists, these trained healthcare personnel have begun to treat a variety of cancers that generally respond well to therapy, including breast, cervical, rectal, squamous head and neck cancer, Hodgkin's and non-Hodgkin's lymphoma, and Kaposi's sarcoma.

One success story in Africa has been the improvement already seen in some areas in the treatment of Burkitt's lymphoma, the most common childhood cancer found in Equatorial Africa. Much of that achievement is credited to Ian Magrath, MB, BS, president of the International Network for Cancer Treatment and Research, who has worked in Africa for decades.

In a recent article in Cancer World, Dr. Magrath reflects on some of the lessons he has learned from that experience. The obstacles to good cancer care in resource-poor countries are completely different than those in wealthier nations, he points out, and emphasizes the necessity of understanding local resource limitations. "You have to be prepared to train and educate the professional staff — select a disease or discipline, and 1 or more centers, and try to develop those into centers of excellence or reference centers," he says.

These centers then become resources in their own countries, and serve as training facilities and improve access to diagnosis, treatment, and palliative care in other countries, he notes.

CA Cancer J Clin. Published online February 4, 2011.